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1.
Epilepsy Behav ; 116: 107740, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33545652

RESUMO

OBJECTIVE: To assess feasibility, patient satisfaction, and financial advantages of telemedicine for epilepsy ambulatory care during the current COVID-19 pandemic. METHODS: The demographic and clinical characteristics of all consecutive patients evaluated via telemedicine at a level 4 epilepsy center between March 20 and April 20, 2020 were obtained retrospectively from electronic medical records. A telephone survey to assess patient satisfaction and preferences was conducted within one month following the initial visit. RESULTS: Among 223 telehealth patients, 85.7% used both synchronous audio and video technology. During the visits, 39% of patients had their anticonvulsants adjusted while 18.8% and 11.2% were referred to laboratory/diagnostic testing and specialty consults, respectively. In a post-visit survey, the highest degree of satisfaction with care was expressed by 76.9% of patients. The degree of satisfaction tended to increase the further a patient lived from the clinic (p = 0.05). Beyond the pandemic, 89% of patients reported a preference for continuing telemedicine if their epilepsy symptoms remained stable, while only 44.4% chose telemedicine should their symptoms worsen. Inclement weather and lack of transportation were factors favoring continued use of telemedicine. An estimated cost saving to patient attributed to telemedicine was $30.20 ±â€¯3.8 per visit. SIGNIFICANCE: Our findings suggest that epilepsy care via telemedicine provided high satisfaction and economic benefit, without compromising patients' quality of care, thereby supporting the use of virtual care during current and future epidemiological fallouts. Beyond the current pandemic, patients with stable seizure symptoms may prefer to use telemedicine for their epilepsy care.


Assuntos
Instituições de Assistência Ambulatorial , Assistência Ambulatorial/métodos , COVID-19/epidemiologia , Epilepsia/epidemiologia , Epilepsia/terapia , Telemedicina/métodos , Adulto , Assistência Ambulatorial/tendências , Instituições de Assistência Ambulatorial/tendências , COVID-19/prevenção & controle , Registros Eletrônicos de Saúde/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Satisfação do Paciente , Encaminhamento e Consulta/tendências , Estudos Retrospectivos , Inquéritos e Questionários , Telemedicina/tendências
2.
Pediatrics ; 147(2)2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33397689

RESUMO

BACKGROUND: Data on anxiety, depression, and attention-deficit/hyperactivity disorder (ADHD) are lacking for youth with congenital heart disease (CHD), particularly those with simple CHD. This study aims to characterize these disorders in youth with CHD compared to those without CHD. METHODS: A comparative cross-sectional study was conducted by using the electronic medical records of a large tertiary care hospital between 2011 and 2016. Inclusion criteria were youth aged 4 to 17 years with >1 hospitalization or emergency department visits. Exclusion criteria were patients with arrhythmias or treatment with clonidine and/or benzodiazepines. The primary predictor variable was CHD type: simple, complex nonsingle ventricle, and complex single ventricle. The primary outcome variable was a diagnosis and/or medication for anxiety and/or depression or ADHD. Data were analyzed by using logistic regression (Stata v15; Stata Corp, College Station, TX). RESULTS: We identified 118 785 patients, 1164 with CHD. Overall, 18.2% (n = 212) of patients with CHD had a diagnosis or medication for anxiety or depression, compared with 5.2% (n = 6088) of those without CHD. All youth with CHD had significantly higher odds of anxiety and/or depression or ADHD. Children aged 4 to 9 years with simple CHD had ∼5 times higher odds (odds ratio: 5.23; 95% confidence interval: 3.87-7.07) and those with complex single ventricle CHD had ∼7 times higher odds (odds ratio: 7.46; 95% confidence interval: 3.70-15.07) of diagnosis or treatment for anxiety and/or depression. Minority and uninsured youth were significantly less likely to be diagnosed or treated for anxiety and/or depression or ADHD, regardless of disease severity. CONCLUSIONS: Youth with CHD of all severities have significantly higher odds of anxiety and/or depression and ADHD compared to those without CHD. Screening for these conditions should be considered in all patients with CHD.


Assuntos
Ansiedade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Depressão/epidemiologia , Cardiopatias Congênitas/epidemiologia , Adolescente , Ansiedade/diagnóstico , Ansiedade/psicologia , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Criança , Pré-Escolar , Estudos Transversais , Depressão/diagnóstico , Depressão/psicologia , Registros Eletrônicos de Saúde/tendências , Feminino , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/psicologia , Humanos , Masculino , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia
3.
J Med Internet Res ; 23(1): e17500, 2021 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-33439126

RESUMO

BACKGROUND: General practices (GPs) in England have recently introduced a nationwide electronic personal health record (ePHR) system called Patient Online or GP online services, which allows patients to view parts of their medical records, book appointments, and request prescription refills. Although this system is free of charge, its adoption rates are low. To improve patients' adoption and implementation success of the system, it is important to understand the factors affecting their use of the system. OBJECTIVE: The aim of this study is to explore patients' perspectives of factors affecting their use of ePHRs in England. METHODS: A cross-sectional survey was carried out between August 21 and September 26, 2017. A questionnaire was used in this survey to collect mainly quantitative data through closed-ended questions in addition to qualitative data through an open-ended question. A convenience sample was recruited in 4 GPs in West Yorkshire, England. Given that the quantitative data were analyzed in a previous study, we analyzed the qualitative data using thematic analysis. RESULTS: Of the 800 eligible patients invited to participate in the survey, 624 (78.0%) returned a fully completed questionnaire. Of those returned questionnaires, the open-ended question was answered by 136/624 (21.8%) participants. A total of 2 meta-themes emerged from participants' responses. The first meta-theme comprises 5 themes about why patients do not use Patient Online: concerns about using Patient Online, lack of awareness of Patient Online, challenges regarding internet and computers, perceived characteristics of nonusers, and preference for personal contact. The second meta-theme contains 1 theme about why patients use Patient Online: encouraging features of Patient Online. CONCLUSIONS: The challenges and concerns that impede the use of Patient Online seem to be of greater importance than the facilitators that encourage its use. There are practical considerations that, if incorporated into the system, are likely to improve its adoption rate: Patient Online should be useful, easy to use, secure, and easy to access. Different channels should be used to increase the awareness of the system, and GPs should ease registration with the system and provide manuals, training sessions, and technical support. More research is needed to assess the effect of the new factors found in this study (eg, lack of trust, difficulty registering with Patient Online) and factors affecting the continuing use of the system.


Assuntos
Registros Eletrônicos de Saúde/tendências , Adolescente , Adulto , Idoso , Estudos Transversais , Inglaterra , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Inquéritos e Questionários , Adulto Jovem
4.
J Nurs Adm ; 51(1): 43-48, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33278201

RESUMO

OBJECTIVE: To examine changes in registered nurse (RN) perceptions of electronic documentation over a 4-year period. BACKGROUND: The investigators previously reported differences in RN perceptions prior to and 1 year after adoption of a comprehensive electronic health record (EHR). METHODS: Investigators repeated the study 4 years after adoption, using the Nurses' Perceptions of Electronic Documentation tool and interviews with a subset of RNs. RESULTS: Nurses scored higher on ease of use domain and lower on concern about the EHR domain and showed no difference on the impacts of the EHR domain. Interviews revealed that 4 years later, some aspects of documentation were easier; the tool was comprehensive, but not without risk, and nurses remained ambivalent about the EHR. CONCLUSIONS: Use of EHR technology impacts nursing work. It is important to understand how nurses' perceptions change over time. This study gives nursing leaders insight into adoption and acceptance of an EHR.


Assuntos
Documentação/normas , Enfermeiras e Enfermeiros/psicologia , Percepção , Atitude Frente aos Computadores , Documentação/métodos , Documentação/tendências , Registros Eletrônicos de Saúde/instrumentação , Registros Eletrônicos de Saúde/normas , Registros Eletrônicos de Saúde/tendências , Humanos , Enfermeiras e Enfermeiros/normas , Enfermeiras e Enfermeiros/tendências , Inquéritos e Questionários
6.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32817268

RESUMO

BACKGROUND: Although required for healing, sleep is often disrupted during hospitalization. Blood pressure (BP) monitoring can be especially disruptive for pediatric inpatients and has few clinical indications. Our aim in this pilot study was to reduce unnecessary overnight BP monitoring and improve sleep for pediatric inpatients. METHODS: The intervention in June 2018 involved clinician education sessions and updated electronic health record (EHR) orders that enabled the forgoing of overnight BP checks. The postintervention period from July 2018 to May 2019 examined patient-caregiver surveys as outcome measures. These surveys measured inpatient sleep and overnight disruptions and were adopted from validated surveys: the Patient Sleep Questionnaire, expanded Brief Infant Sleep Questionnaire, and Potential Hospital Sleep Disruptions and Noises Questionnaire. Uptake of new sleep-friendly EHR orders was a process measure. Reported patient care escalations served as a balancing measure. RESULTS: Interrupted time series analysis of EHR orders (npre = 493; npost = 1472) showed an increase in intercept for the proportion of patients forgoing overnight BP postintervention (+50.7%; 95% confidence interval 41.2% to 60.3%; P < .001) and a subsequent decrease in slope each week (-0.16%; 95% confidence interval -0.32% to -0.01%; P = .037). Statistical process control of surveys (npre = 263; npost = 131) showed a significant increase in sleep duration for patients older than 2, and nighttime disruptions by clinicians decreased by 19% (P < .001). Annual estimated cost savings were $15 842.01. No major adverse events in patients forgoing BP were reported. CONCLUSIONS: A pilot study combining EHR changes and clinician education safely decreased overnight BP checks, increased pediatric inpatient sleep duration, and reduced nighttime disruptions by clinicians.


Assuntos
Determinação da Pressão Arterial/normas , Criança Hospitalizada , Pessoal de Saúde/normas , Análise de Séries Temporais Interrompida/normas , Melhoria de Qualidade/normas , Sono/fisiologia , Adolescente , Determinação da Pressão Arterial/psicologia , Determinação da Pressão Arterial/tendências , Cuidadores/educação , Cuidadores/normas , Cuidadores/tendências , Criança , Criança Hospitalizada/psicologia , Pré-Escolar , Registros Eletrônicos de Saúde/normas , Registros Eletrônicos de Saúde/tendências , Feminino , Pessoal de Saúde/educação , Pessoal de Saúde/tendências , Humanos , Lactente , Recém-Nascido , Análise de Séries Temporais Interrompida/tendências , Masculino , Projetos Piloto , Estudos Prospectivos , Melhoria de Qualidade/tendências
7.
PLoS One ; 15(7): e0234845, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32609766

RESUMO

Epidemiological evidence from prospective cohort studies on risk factors of Parkinson's disease (PD) is limited as case ascertainment is challenging due to a lack of registries and the disease course of PD. The objective of this study was to create a case ascertainment method for PD within two prospective Dutch cohorts based on multiple sources of PD information. This method was validated using clinical records from the general practitioners (GPs). Face validity of the case ascertainment was tested for three etiological factors (smoking, sex and family history of PD). In total 54825 participants were included from the cohorts AMIGO and EPIC-NL. Sources of PD information included self-reported PD, self-reported PD medication, a 9 item screening questionnaire (Tanner), electronical medical records, hospital discharge data and mortality records. Based on these sources we developed a likelihood score with 4 categories (no PD, unlikely PD, possible PD, likely PD). For the different sources of PD information and for the likelihood score we present the agreement with GP-validated cases. Risk of PD for established factors was studied by logistic regression as exact diagnose dates were not always available. Based on the algorithm, we assigned 346 participants to the likely PD category. GP validation confirmed 67% of these participants in EPIC-NL, but only 12% in AMIGO. PD was confirmed in only 3% of the participants with a possible PD classification. PD case ascertainment by mortality records (91%), EMR ICPC (82%) and self-reported information (62-69%) had the highest confirmation rates. The Tanner PD screening questionnaire had a lower agreement (18%). Risk estimates for smoking, family history and sex using all likely PD cases were comparable to the literature for EPIC-NL, but not for smoking in AMIGO. Using multiple sources of PD evidence in cohorts remains important but challenging as performance of sources varied in validity.


Assuntos
Doença de Parkinson/diagnóstico , Doença de Parkinson/epidemiologia , Idoso , Estudos de Coortes , Registros Eletrônicos de Saúde/tendências , Feminino , Recursos em Saúde/tendências , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Países Baixos , Estudos Prospectivos , Sistema de Registros , Fatores de Risco , Autorrelato
10.
Saudi Med J ; 41(6): 583-589, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32518923

RESUMO

A few decades ago, the government of Saudi Arabia introduced electronic medical records (EMRs) in some health care facilities. However, the progress in adopting these systems on a national level was slow. In 2008, the Saudi Ministry of Health started an initiative to expand and optimize the use of EMRs in governmental health care institutions. However, some obstacles facing this ambitious plan remain, including negative attitudes of some health care professionals toward EMR systems. Other barriers include poor computer literacy, lack of system customization to hospital needs, and poor support and training from information technology (IT) personnel. Identifying and addressing these barriers is essential for the optimal application of EMR systems in all health care facilities. In this review, the author focused on the benefits of widespread adoption of EMRs in Saudi Arabia, the perceptions of health care professionals, and the challenges and barriers toward improved implementation of this technology.


Assuntos
Atitude do Pessoal de Saúde , Atenção à Saúde/métodos , Atenção à Saúde/tendências , Registros Eletrônicos de Saúde , Promoção da Saúde , Registros Eletrônicos de Saúde/tendências , Humanos , Atenção Primária à Saúde , Arábia Saudita
13.
Comput Inform Nurs ; 38(5): 232-239, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32310833

RESUMO

Rapid deployment of electronic health records has resulted in a need for simulation centers to integrate the use of electronic health records into simulation-based learning activities within the clinical workflow. To assess the quality of the documentation in the electronic health record, the Competency Assessment in Simulation of Electronic Health Records Tool was developed. Lynn's method of content validity, combined with nominal group and Delphi techniques, was used to identify 15 domains of best practice in documentation. Participants with expertise in academic education, simulation, and informatics provided input into the development of the tool. The tool evolved over three rounds of Delphi that refined the language and provided anchors to promote accurate assessment of student and nurse documentation. The results of the Delphi narrowed the 15 domains down to 10 domains for scoring best practices in electronic documentation within simulation-based learning activities. The Competency Assessment in Simulation of Electronic Health Records Tool was developed to address the electronic health record competencies of both nursing students and practicing nurses in a simulation environment.


Assuntos
Simulação por Computador , Registros Eletrônicos de Saúde/tendências , Software/normas , Técnica Delfos , Humanos , Software/tendências
15.
Anesth Analg ; 130(5): 1133-1146, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32287121

RESUMO

Use of the electronic health record (EHR) has become a routine part of perioperative care in the United States. Secondary use of EHR data includes research, quality, and educational initiatives. Fundamental to secondary use is a framework to ensure fidelity, transparency, and completeness of the source data. In developing this framework, competing priorities must be considered as to which data sources are used and how data are organized and incorporated into a useable format. In assembling perioperative data from diverse institutions across the United States and Europe, the Multicenter Perioperative Outcomes Group (MPOG) has developed methods to support such a framework. This special article outlines how MPOG has approached considerations of data structure, validation, and accessibility to support multicenter integration of perioperative EHRs. In this multicenter practice registry, MPOG has developed processes to extract data from the perioperative EHR; transform data into a standardized format; and validate, deidentify, and transfer data to a secure central Coordinating Center database. Participating institutions may obtain access to this central database, governed by quality and research committees, to inform clinical practice and contribute to the scientific and clinical communities. Through a rigorous and standardized approach to ensure data integrity, MPOG enables data to be usable for quality improvement and advancing scientific knowledge. As of March 2019, our collaboration of 46 hospitals has accrued 10.7 million anesthesia records with associated perioperative EHR data across heterogeneous vendors. Facilitated by MPOG, each site retains access to a local repository containing all site-specific perioperative data, distinct from source EHRs and readily available for local research, quality, and educational initiatives. Through committee approval processes, investigators at participating sites may additionally access multicenter data for similar initiatives. Emerging from this work are 4 considerations that our group has prioritized to improve data quality: (1) data should be available at the local level before Coordinating Center transfer; (2) data should be rigorously validated against standardized metrics before use; (3) data should be curated into computable phenotypes that are easily accessible; and (4) data should be collected for both research and quality improvement purposes because these complementary goals bolster the strength of each endeavor.


Assuntos
Pesquisa Biomédica/normas , Registros Eletrônicos de Saúde/normas , Estudos Multicêntricos como Assunto/normas , Avaliação de Resultados em Cuidados de Saúde/normas , Assistência Perioperatória/normas , Melhoria de Qualidade/normas , Pesquisa Biomédica/tendências , Registros Eletrônicos de Saúde/tendências , Humanos , Avaliação de Resultados em Cuidados de Saúde/tendências , Assistência Perioperatória/tendências , Melhoria de Qualidade/tendências
16.
Tex Med ; 116(3): 23-25, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32232803

RESUMO

Texas developed the AIDS Regional Information and Evaluation System in the early 1990s to administer federal grants from the then-new Ryan White program, which provides HIV- and AIDS-related health services for patients who can't get health care coverage or financial resources any other way. Physicians say the reservoir of medical data can be valuable, and without it, they can't get the funds they need to treat these patients. But the outdated reporting system - which still operates on 1990s technology - causes serious headaches and detracts from patient care.


Assuntos
Síndrome de Imunodeficiência Adquirida/terapia , Registros Eletrônicos de Saúde/tendências , Infecções por HIV/terapia , Administração Financeira , Humanos , Texas
17.
Comput Inform Nurs ; 38(7): 338-348, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32149742

RESUMO

The wide adoption of electronic medical records and subsequent availability of large amounts of clinical data provide a rich resource for researchers. However, the secondary use of clinical data for research purposes is not without limitations. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic review to identify current issues related to secondary use of electronic medical record data via MEDLINE and CINAHL databases. All articles published until June 2018 were included. Sixty articles remained after title and abstract review, and four domains of potential limitations were identified: (1) data quality issues, present in 91.7% of the articles reviewed; (2) data preprocessing challenges (53.3%); (3) privacy concerns (18.3%); and (4) potential for limited generalizability (21.7%). Researchers must be aware of the limitations inherent to the use of electronic medical record data for research and consider the potential effects of these limitations throughout the entire study process, from initial conceptualization to the identification of adequate sources that can provide data appropriate for answering the research questions, analysis, and reporting study results. Consideration should also be given to using existing data quality assessment frameworks to facilitate use of standardized data quality definitions and further efforts of standard data quality reporting in publications.


Assuntos
Registros Eletrônicos de Saúde/tendências , Pesquisa/instrumentação , Confiabilidade dos Dados , Registros Eletrônicos de Saúde/normas , Humanos , Pesquisa/tendências
18.
Aust J Gen Pract ; 49(3): 145-150, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32113209

RESUMO

BACKGROUND AND OBJECTIVES: General practice electronic health records (EHRs) are a rich source of primary care data that can be used for important research. The aim of this qualitative study was to analyse the attitudes of Australian general practitioners (GPs) to the use of data extracted from primary care EHRs for clinical research. METHOD: Semi-structured interviews were conducted with 13 Australian GPs. Interviews were recorded, transcribed and thematically analysed. RESULTS: Two main themes emerged. The data custodian role encompassed GPs' determination to maintain privacy, their trust of organisations involved and benefits of research outcomes. The theme of protecting practice resources included concerns about unrecompensed staff time and potential risks to data and systems. DISCUSSION: This study highlights that while Australian GPs have concerns about the use of data stored on their EHRs, they also recognise the benefits of using this data for research purposes. Addressing these concerns could help to ensure that researchers have access to this valuable and rich data resource.


Assuntos
Atitude do Pessoal de Saúde , Coleta de Dados/normas , Registros Eletrônicos de Saúde/tendências , Clínicos Gerais/psicologia , Austrália , Coleta de Dados/métodos , Clínicos Gerais/tendências , Humanos , Entrevistas como Assunto/métodos , Pesquisa Qualitativa
19.
Goiânia; SES-GO; 17 fev. 2020. 1-2 p.
Não convencional em Português | LILACS, Coleciona SUS, CONASS, SES-GO | ID: biblio-1128470

RESUMO

As principais vantagens apontadas, pela literatura, para os prontuários eletrônicos são melhor acesso, maior segurança e novos recursos, de modo que sua implantação possa se justificar pela melhoria na qualidade da assistência à saúde do paciente, pelo melhor gerenciamento dos recursos e pela melhoria de processos administrativos e financeiros. E as desvantagens envolvem o custo de implantação, tempo necessário para se avaliar os resultados, sujeição a falhas operacionais (COSTA, 2001)


The main advantages pointed out by the literature for electronic medical records are better access, greater security and new resources, so that their implementation can be justified by the improvement in the quality of patient health care, better management of resources and improvement of administrative and financial processes. And the disadvantages involve the cost of implementation, time required to evaluate the results, subjection to operational failures (COSTA, 2001)


Assuntos
Humanos , Registros Eletrônicos de Saúde/história , Registros Eletrônicos de Saúde/tendências
20.
Rev Epidemiol Sante Publique ; 68(2): 117-123, 2020 Apr.
Artigo em Francês | MEDLINE | ID: mdl-31974001

RESUMO

The recent opening of massive health databases, as well as the development of methods and tools adapted to their data processing, questions the French model of "morbidity registry". In France in 2019, nearly 61 health registries were operating. As defined by law, these registries identify exhaustively all patients with a given disease in a given territory. Established several decades ago, these registries are part of the French surveillance system that is used for research and evaluation purposes. Since the advent of recent technological progress, large-scale databases are made available to researchers and it is possible with these databases to answer questions initially assigned to the registries. What is the place of such registries in this new context: are they obsolete or still useful? Should they be opposed to the new tools or are they complementary to them, and if so, what is their place in the new French public health ecosystem? The objective of this work was to assess the roles and missions of existing registries and to reflect on their positioning in this new environment. The French model of registry is sometimes questioned because of the complexity of its circuits, requiring a significant amount of human resources. However, the data that constitute them, validated by cross-checking information from several sources, are of very high quality, and make it possible to validate the data in the new databases (National Health Data System (NSDS) or Hospital Data Warehouses). Registries and new databases are in fact complementary, and far from jeopardizing this model, the recent opening of these databases represents an opportunity for registries to modernize their operations and respond to new missions.


Assuntos
Big Data , Bases de Dados Factuais/tendências , Morbidade , Saúde Pública/tendências , Sistema de Registros , Big Data/provisão & distribuição , Bases de Dados Factuais/normas , Bases de Dados Factuais/provisão & distribuição , Registros Eletrônicos de Saúde/organização & administração , Registros Eletrônicos de Saúde/normas , Registros Eletrônicos de Saúde/tendências , França/epidemiologia , Gestão da Informação em Saúde/organização & administração , Gestão da Informação em Saúde/normas , Gestão da Informação em Saúde/tendências , Humanos , Disseminação de Informação/métodos , Modelos Organizacionais , Prática Profissional/organização & administração , Prática Profissional/normas , Prática Profissional/tendências , Papel Profissional , Saúde Pública/estatística & dados numéricos , Sistema de Registros/normas , Sistema de Registros/estatística & dados numéricos
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